Some 25 states have signed onto the Enhanced Nurse Licensure Compact, and 26 are needed for ratification. The compact would enable nurses to practice telehealth in multiple states with one license.

July 06, 2017 - Nurses will soon be able to practice telehealth in multiple states under one license.

With recent votes by legislators in Texas, Maine and Delaware, 25 states have agreed to join the Enhanced Nurse Licensure Compact (eNLC). The compact, overseen by the National Council of State Boards of Nursing, is activated when 26 states sign on or by the end of 2018.

The eNLC, an enhanced version of the Nurse Licensure Compact originally introduced in 1997 and implemented in 2000, allows for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to practice in any member state under one license. Licensing standards are aligned in member states so that nurses applying for a multistate license are required to meet the same standards, which include a federal and state criminal background check.

"Adoption of the eNLC ensures that our licensees have mobility across state borders using their multistate licenses as well as improving access to care and maintaining public protection," Valerie Fuller, DNP, PhD, AGACNP-BC, FAANP, president of the Maine State Board of Nursing, said in a June 27 release following Maine’s vote.

While the original NLC was designed to make it easier for nurses to work across state lines, the eNLC, introduced in 2015, specifically targeted “the growing need for nurse mobility and clarification of the authority to practice for many nurses currently engaged in telenursing or interstate practice.”

“Many providers on the phone with a patient don’t ask the question, ‘Where are you at?’” Elliott Vice, the NCSBN’s director of government affairs with the NCSBN, said during a 2016 forum organized by the American Telemedicine Association, a supporter of the eNLC. “What we’re trying to do is put in a legal structure that facilitates” telehealth and makes that question unnecessary.

“This is no longer just the bedside,” he said. “It’s telehealth. It’s nursing. It’s everything.”

With activation on the horizon – Politico reported today that North Carolina legislators are moving toward approving the eNLC – the compact would become the third to go live, joining similar efforts for physicians and physical therapists.

The Interstate Medical Licensure Compact for physicians, overseen by the Federation of State Medical Boards, went live on April 6, but has been plagued by a dispute with the FBI over access to criminal records for background checks. To date, some 25 states have signed onto that compact, but only a few are processing license applications.

On April 25, meanwhile, Washington became the 10th state to sign onto the Physical Therapy Licensure Compact, overseen by the Federation of State Boards for Physical Therapy (FSBPT), enabling that compact to go live. In all, 13 states have now joined that compact.

Nevada, Arizona and New Mexico have agreed to implement the Psychology Interjurisdictional Compact(PsyPACT), overseen by The Association of State and Provincial Psychology Boards, while Texas, Illinois and Rhode Island have pending legislation and Wisconsin, New Mexico, Missouri and Ohio are considering it. That compact goes live with ratification by seven states.

In a recent blog, Marlene Maheu, founder and executive director of the TeleMental Health Institute, said several groups, including the American Association of State Counseling Boards (AASCB), the Association of Counselor Education and Supervision (ACES), the American Mental Health Counselors Association (AMHCA) and the National Board for Certified Counselors (NBCC), are working to enhance multistate services for more members of the counseling profession.

“Healthcare providers across behavioral and related disciplines have long seen licensure as a barrier to telehealth growth,” Maheu wrote. “Practitioners are seeking to not only develop their specialty niche and make themselves available to more patients but also to companies seeking to create multi-state services. Regardless of the discipline, the fetters of outdated and often contradictory state regulatory requirements have led to growing discontent with existing interjurisdictional barriers as well as a focused effort on the part of many disciplines to keep up with 21st century lifestyles.”

NCSB officials says the eNLC will give nurses the freedom to practice telehealth in multistate health networks, as well as helping during large-scale emergencies.

“The eNLC enables nurses to provide telehealth nursing services to patients located across the country without having to obtain additional licenses,” the organization says in a press release. “In the event of a disaster, nurses from multiple states can easily respond to supply vital services. Additionally, almost every nurse, including primary care nurses, case managers, transport nurses, school and hospice nurses, among many others, needs to routinely cross state boundaries to provide the public with access to nursing services, and a multistate license facilitates this process.”